Heart Health After 45: The Tests, Numbers, and Symptoms Every Woman Should Know

Dr. Arash Bereliani, MD, FACC, a board-certified cardiologist and Medical Director of the Beverly Hills Institute for Cardiology and Preventive Medicine, joined this week’s Studio Session to walk through the heart health numbers every woman over 45 should know — and why a clean cholesterol panel isn’t the reassurance most of us think it is.

Most women can recite their cholesterol number, but that number alone misses a lot of risk. “About 50 percent of people that get heart attacks have ‘normal’ cholesterol,” Dr. Bereliani said. This is why he pushes patients toward two additional markers: ApoB, a marker that may predict future heart disease more reliably than LDL cholesterol alone, and lipoprotein(a), a genetic, “sticky” form of cholesterol that isn’t affected by diet or exercise and — unlike cholesterol — only needs to be checked once in your life.

Cholesterol numbers alone also don’t explain why plaque actually ruptures and triggers a heart attack — that’s where inflammation comes in. Dr. Bereliani described hs-CRP as “a smoke detector for inflammation,” and walked through what a coronary calcium score can and can’t tell you: a calcium score of zero has been linked to an extremely low heart attack risk over the following 18 years, what he calls “the power of zero”. The scan, though, can still miss dangerous soft, non-calcified plaque, which is why he recommends a carotid ultrasound for every woman over 45 to 50.

Much of this risk shifts at menopause. Losing estrogen’s protective effect on blood vessels, combined with rising stress hormones and weight gain, makes menopause a genuine inflection point for cardiovascular risk, Dr. Bereliani said. Hormone therapy can help when it’s timed right, generally started within about ten years of menopause or before age 60, using a transdermal form (patch, gel, or cream) rather than an oral pill, which carries a higher clotting risk.

He also covered how GLP-1 medications like Wegovy and Ozempic affect heart risk (and why they’re not a substitute for cholesterol medication), what untreated sleep apnea does to the cardiovascular system, and which supplements are (and aren’t) worth considering.

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